Editing Postpartum depression (section)

==Society and culture==
=== Legal recognition ===
Recently, postpartum depression has become more widely recognized in society. In the US, the [[Patient Protection and Affordable Care Act]] included a section focusing on research into postpartum conditions including postpartum depression.<ref>{{cite journal | vauthors = Rhodes AM, Segre LS | title = Perinatal depression: a review of US legislation and law | journal = Archives of Women's Mental Health | volume = 16 | issue = 4 | pages = 259–270 | date = August 2013 | pmid = 23740222 | pmc = 3725295 | doi = 10.1007/s00737-013-0359-6 }}</ref> Some argue that more resources in the form of policies, programs, and health objectives need to be directed to the care of those with PPD.<ref>{{cite journal | vauthors = Cheng CY, Fowles ER, Walker LO | title = Continuing education module: postpartum maternal health care in the United States: a critical review | journal = The Journal of Perinatal Education | volume = 15 | issue = 3 | pages = 34–42 | date = 2006 | pmid = 17541458 | pmc = 1595301 | doi = 10.1624/105812406X119002 }}</ref>

=== Role of stigma ===
When stigma occurs, a person is labeled by their illness and viewed as part of a stereotyped group. There are three main elements of stigmas, 1) problems of knowledge (ignorance or misinformation), 2) problems of attitudes (prejudice), and 3) problems of behavior (discrimination).<ref name="Thorsteinsson_2018">{{cite journal | vauthors = Thorsteinsson EB, Loi NM, Farr K | title = Changes in stigma and help-seeking in relation to postpartum depression: non-clinical parenting intervention sample | journal = PeerJ | volume = 6 | pages = e5893 | date = 2018-11-08 | pmid = 30425892 | pmc = 6230434 | doi = 10.7717/peerj.5893 | doi-access = free }}</ref> Specifically regarding PPD, it is often left untreated as women frequently report feeling ashamed about seeking help and are concerned about being labeled as a "bad mother" if they acknowledge that they are experiencing depression.<ref name="Thorsteinsson_2018" /> Although there has been previous research interest in depression-related stigma, few studies have addressed PPD stigma. One study studied PPD stigma by examining how an education intervention would impact it. They hypothesized that an education intervention would significantly influence PPD stigma scores.<ref name="Thorsteinsson_2018" /> Although they found some consistency with previous mental health stigma studies, for example, that males had higher levels of personal PPD stigma than females, most of the PPD results were inconsistent with other mental health studies.<ref name="Thorsteinsson_2018" /> For example, they hypothesized that education intervention would lower PPD stigma scores, but in reality, there was no significant impact, and also familiarity with PPD was not associated with one's stigma towards people with PPD.<ref name="Thorsteinsson_2018" /> This study was a strong starting point for further PPD research but indicates more needs to be done to learn what the most effective anti-stigma strategies are specifically for PPD.<ref name="Thorsteinsson_2018" />

Postpartum depression is still linked to significant stigma. This can also be difficult when trying to determine the true prevalence of postpartum depression. Participants in studies about PPD carry their beliefs, perceptions, cultural context, and stigma of mental health in their cultures with them which can affect data.<ref name="Halbreich_2006"/> The stigma of mental health - with or without support from family members and health professionals - often deters women from seeking help for their PPD. When medical help is achieved, some women find the diagnosis helpful and encourage a higher profile for PPD amongst the health professional community.<ref name="Halbreich_2006" />

=== Cultural beliefs ===
Postpartum depression can be influenced by sociocultural factors.<ref name="Halbreich_2006" /> There are many examples of particular cultures and societies that hold specific beliefs about PPD.

[[Malay culture]] holds a belief in Hantu Meroyan; a spirit that resides in the placenta and amniotic fluid.<ref>{{cite book| vauthors = Laderman C |title=Wives and midwives: childbirth and nutrition in rural Malaysia|date=1987|publisher=University of California Press|isbn=978-0-520-06036-4|edition=1st pbk.|location=Berkeley|page=202}}</ref> When this spirit is unsatisfied and venting resentment, it causes the mother to experience frequent crying, loss of appetite, and trouble sleeping, known collectively as "sakit meroyan". The mother can be cured with the help of a [[shaman]], who performs a [[séance]] to force the spirits to leave.<ref name="-20092">{{cite book|title=Medical Anthropology in Ecological Perspective|year=2009|isbn=978-0-7867-2740-7| veditors = McElroy A, Townsend PK |pages=217–66|chapter=Culture, Ecology, and Reproduction }}</ref>

Some cultures believe that the symptoms of postpartum depression or similar illnesses can be avoided through protective rituals in the period after birth. These may include offering structures of organized support, hygiene care, diet, rest, infant care, and breastfeeding instruction.<ref name="Dennis_2007"/> The rituals appear to be most effective when the support is welcomed by the mother.<ref name="Grigoriadis_2009"/>

Some Chinese women [[Postpartum confinement|participate in a ritual]] that is known as "doing the month" (confinement) in which they spend the first 30 days after giving birth resting in bed, while the mother or mother-in-law takes care of domestic duties and childcare. In addition, the new mother is not allowed to bathe or shower, wash her hair, clean her teeth, leave the house, or be blown by the wind.<ref name="-2009032">{{cite journal | vauthors = Klainin P, Arthur DG | title = Postpartum depression in Asian cultures: a literature review | journal = International Journal of Nursing Studies | volume = 46 | issue = 10 | pages = 1355–1373 | date = October 2009 | pmid = 19327773 | doi = 10.1016/j.ijnurstu.2009.02.012 | s2cid = 19493163 }}</ref>

The relationship with the [[Parent-in-law|mother-in-law]] has been identified as a significant risk factor for postpartum depression in many Arab regions. Based on cultural beliefs that place importance on mothers, mothers-in-law have significant influences on daughters-in-law and grandchildren's lives in such societies as the husbands frequently have close relationships with their family of origin, including living together.<ref name="Haque_2015" />

Furthermore, cultural factors influence how [[Middle East]]ern women are screened for PPD. The traditional [[Edinburgh Postnatal Depression Scale]], or EPDS, has come under criticism for emphasizing depression symptoms that may not be consistent with [[Muslims|Muslim]] cultural standards. Thoughts of self-harm are strictly prohibited in [[Islam]], yet it is a major symptom within the EPDS. Words like "depression screen" or "mental health" are considered disrespectful to some [[Arabs|Arab]] cultures. Furthermore, women may under report symptoms to put the needs of the family before their own because these countries have [[Collectivism|collectivist]] cultures.<ref name="Haque_2015" />

Additionally, research showed that mothers of female babies had a considerably higher risk of PPD, ranging from 2-4 times higher than those of mothers of male babies, due to the value certain cultures in the Middle East place on female babies compared to male babies.<ref name="Ayoub_2020" />

=== Media ===
Certain cases of postpartum mental health concerns received attention in the media and brought about dialogue on ways to address and understand more about postpartum mental health. [[Andrea Yates]], a former nurse, became pregnant for the first time in 1993.<ref name="Coodley_2002">{{cite journal | vauthors = Coodley L | title = Postpartum depression: voice from a historian | journal = Pediatric Nursing | volume = 28 | issue = 3 | page = 300 | date = 2002 | pmid = 12087655 }}</ref> After giving birth to five children in the coming years, she had severe depression and many depressive episodes. This led to her believing that her children needed to be saved and that by killing them, she could rescue their eternal souls. She drowned her children one by one over the course of an hour, by holding their heads underwater in their family bathtub. When called into trial, she felt that she had saved her children rather than harming them and that this action would contribute to defeating Satan.<ref name="Fisher_2003">{{cite journal | vauthors = Fisher K| title = To Save Her Children's Souls: Theoretical Perspectives on Andrea Yates and Postpartum-Related Infanticide. |date=2003 |journal=Thomas Jefferson Law Review|volume=25 | page = 599 }}</ref>

This was one of the first public and notable cases of postpartum psychosis,<ref name="Coodley_2002" /> which helped create a dialogue on women's mental health after childbirth. The court found that Yates was experiencing mental illness concerns, and the trial started the conversation of mental illness in cases of murder and whether or not it would lessen the sentence or not. It also started a dialogue on women going against "maternal instinct" after childbirth and what maternal instinct was truly defined by.<ref name="Fisher_2003" />

Yates' case brought wide media attention to the problem of filicide,<ref>{{cite journal | vauthors = West SG | title = An overview of filicide | journal = Psychiatry | volume = 4 | issue = 2 | pages = 48–57 | date = February 2007 | pmid = 20805899 | pmc = 2922347 }}</ref> or the murder of children by their parents. Throughout history, both men and women have perpetrated this act, but the study of maternal filicide is more extensive.